JOHN HANCOCK LIFE INSURANCE COMPANY Single Purchase Quotation Checklist
We wish to provide you with the most accurate, complete and timely quotation. We ask that your Plan Actuary fill out this Checklist with complete information concerning the Plan provisions available to participants. Please do not attach Plan Documents, or excerpts from the Plan, because we do not review Plan Documents to avoid any misinterpretation. ___________________________________________________________________________
1. 2.
Name of Prospect: ____________________________ Address of Prospect: _______________________ _______________________
3. 4. 5. 6.
Type of Business: _________________________ Name of Consultant: ____________________ Consultant Email Address: __________________ Consultant Address:_______________________________ _______________________________
7. 8. 9.
Date Preliminary Quote Due: ________________ Date Final Quote Due: ____________ Liability Assumption Date:________________ Premium Receipt Date: _____________________
10. State for Premium Tax Assumption (Based on the State of Residence of the participants): ___________________________ 11. Commissions: _____________________________ 12. Qualified Plan (please circle): Yes / No 13. Issue State for Contract: __________________ 14. 15. Plan Termination (please circle): Yes / No If yes, date: _________________
Plan Year: _____________________________
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I. IMMEDIATE ANNUITIES: Life Count: ___________ Accrued Monthly Benefit: $ ______________
Any Post Retirement death benefit other than specified by option (please circle)? Yes / No If Yes, please describe: Any COLA applicable (please circle)? Yes / No If Yes, is interest rate (please circle)?: Fixed / Variable If Fixed, crediting rate is: _______% If Variable, crediting rate is: ____________________________ Please describe calculation of COLA: _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________
II. DEFERRED ANNUITIES: Life Counts Active Terminated Vested __________ __________ Accrued Monthly Benefit $ ______________ $ ______________
Plan’s Normal Retirement Age: ________________ Plan’s Normal Retirement Date: ___________________ Is separation from Service required to begin retirement benefits? Yes / No
NORMAL FORM OF ANNUITY: Married Participants: __________________________________ Unmarried Participants:_________________________________ Page 2
OPTIONAL FORMS OF ANNUITY: Optional Forms of Benefit (please list) (for example) 50% Joint & Survivor; Lump Sum; 5 Yr Certain and Continuous): ___________________ ___________________ ___________________ ___________________ ________________ ________________ ________________ ________________
Option Factors are needed. Please provide a sample. If option factors are not available we will need to know the plan’s actuarial equivalent rate basis. Actuarial Equivalent Interest Rate:_____________________________________________ Actuarial Equivalent Mortality:_________________________________________________ Lump Sum Specific: Is a Lump Sum (non Cashout) Option available (please circle)?: Yes / No If yes, when (please circle)?: Early Retirement / Normal Retirement / Other: ______________ Actuarial Equivalent Interest Rate:___________________________________ Actuarial Equivalent Mortality:________________________________________ Are these factors to be used based on an immediate or deferred basis (please circle)?: Immediate / Deferred
EARLY RETIREMENT DATE: Early Retirement allowed (please circle)?: Yes / No If yes, what are eligibility requirements (ex. age & service)? _________________________________________________________________________ _________________________________________________________________________ ___________________________________________________________________ Page 3
Is termination of employment required to begin receipt of benefits?: Yes / No For Active employees, does service continue to accrue for EOR eligibility (please circle):? Yes / No EOR reduction factors are needed. Please provide: Reduction Formula (ex. 6 2/3% per year prior to age 60):_________________________ Or Actuarial Equivalence: Interest:_____________________________ Mortality: ____________________________ (Please also provide a sample of these factors). LATE RETIREMENT DATE: Any Late Retirement Provisions (please circle)?: Yes / No If Yes (please circle): Retroactive payments / Actuarial Increase
Is termination of employment required to begin receipt of benefits (please circle)?:Yes/No If Retroactive Payments: Has the plan adopted an RASD Provision (please circle)? Yes / No Interest Rate applicable to Retroactive payments: _______% If Actuarial Increase: Interest Rate: _______% Mortality: _____________________ (Please note, if the plan is qualified and terminated after 1/1/04 we will include an Actuarial increase if the plan has not been amended to include a RASD provision.)
PRE-RETIREMENT DEATH BENEFITS: Pre Retirement Death (Spouse’s) Benefit coverage (please circle): Yes / No Available to (please circle): Married / Unmarried / Both Benefit is reduced by:____________50% J & S Option Factor only ____________ EOR Factor ____________ Both
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Is the Pre-Retirement Death Benefit available as a lump sum (please circle)?: Yes / No If yes, please describe calculation: _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________ Any other Pre-Retirement Death Benefit (please circle)?: Yes / No If yes, please describe: _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________
POST RETIREMENT DEATH BENEFITS: Any Post-Retirement Death Benefits (other than provided by option) (please circle)?: Yes / No If yes, please describe: _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________
MANDATORY LUMP SUM CASHOUT: Cashout Provision (please circle)?: Yes / No If yes: Mandatory / Optional? If yes, at what Present Value amount: $___________________ What is the rate basis?: Interest Rate: ____________________________ Mortality: _________________________________
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ADDITIONAL BENEFITS: Supplemental Benefits (please circle)?: Yes / No If yes, please describe: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _________ Disability Provision (please circle)?: Yes / No (Please note, if yes above, disability must meet the Social Security Administration definition in order to be included in our quote) If Yes, is eligibility the same as for Early Retirement: Yes / No If No, please describe: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _________
EMPLOYEE CONTRIBUTIONS: Contributory (please circle)?: Yes / No If Yes, withdrawals of EE Accumulations permitted at: _____retirement _____death _____termination _____at any time _____special one time election
Residual Annuity applicable (please circle)? Yes / No
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EMPLOYEE CONTRIBUTIONS (Continued):
If yes, how is the Residual Annuity determined and administered? _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ ____________
EE Accums, on submitted data are accrued to (date)? ___________ Rate of interest to be used to update EE Accums. ____________%
RELATIVE VALUE REGULATIONS: Section 1.401(a)-20, provides that, in the case of a married Participant, the QJSA must be at least as valuable as any other optional form of benefit payable under the plan at the same time. Section 417(e)(3) provides that specified mortality and interest rate assumptions apply in determining the minimum present value of certain optional forms of benefit, such as a single sum. Please provide the following for Relative Value calculations: Interest rate the Plan uses for this calculation: ______________________________ Mortality Table the Plan uses for this calculation: _________________________________________________________________________ _________________________________________________________________________
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